Are we winning the war against cancer? (#4)

Eventual success in cancer control
is achievable but is still distant.
Cancer prevention has advanced spottily where tobacco control has been
imposed, but the scourge continues. Most
chemicals in the marketplace, including in the food chain, are untested and
some are suspect. Imaging methods have
vastly expanded for the better, but we lack a test of blood, urine, or saliva
that has specificity for early cancers.
Surgical techniques for primary tumors have improved as a result of new
instrumentation. Radiation therapy can
be delivered with less collateral damage, but like surgery with little evidence
of increased curative effect. Chemotherapeutic
agents that target specific genes have led to temporary regressions of a few
metastatic cancers, but have not yet been reported of curative potential for
micrometastatic neoplasms. Single gene
targeting assumes single gene indispensability for the cancer state, as is true
in chronic myelocytic leukemia, a singular rarity. Chemotherapeutic agents derived from empiric
testing on experimental cancers still dominate therapy of metastatic and
micrometastatic cancers with some cures for the record. Specific antibodies augment this effect in a
very few neoplasms. Active mobilization
of the host immune system, a golden wish, is still imperfect.

We have not
significantly interrupted the metastatic process. Final common pathways for the cancer process
have been identified, but not successfully interrupted. The distribution of resources for,
information about, and application of anti-cancer efforts is markedly
disparate, with advantage for the three wealthiest continents. The greater populations of cancer patients in
Asia, Africa, and South America are not similarly privileged. Even in Europe, North America, and Australia,
economic factors influence cancer incidence treatment and mortality.

A test or tests
or body fluids for early cancer, an understanding that underpins prevention of
metastasis, achievement of autonomous immunologic defense, and widespread
public health measures to prevent cancer and to apply the best program
universally will likely come, but not yet.